[Expansion in breast surgery]

Skin expansion in breast reconstruction presents several specificities related to mastectomy, retromuscular dissection, and the oncological context. In delayed reconstruction (DR), the local clinical examination is essential to select indications and to eliminate high-risk cases (sequelae of radiotherapy, Halsted, etc.). Immediate reconstruction (IR) must be reserved for motivated patients in whom mastectomy represents the last stage of treatment. The patient must be well informed before the operation. The choice of expander depends on the width of the breast to be reconstructed. Precise drawings are made in the standing position. In the case of DR, the prosthesis is inserted retropectorally superiorly and subcutaneously inferiorly. In IR, a complete retromuscular compartment must be created. Inflation begins after healing at a weekly rhythm until the desired volume has been exceeded. Inflation is performed more slowly in the case of previous irradiation. The second stage is performed three months after the end of inflation. After removal of the expander, the periprosthetic capsule of the compartment can be modified when necessary. The choice of the final prosthesis, preferably with an anatomical shape, is critical in order to obtain the correct volume. When necessary, the inframammary sulcus can be reinforced by internal or external procedures. Other reconstructive procedures (symmetrization, areolar reconstruction) can be associated. The most serious complications are infection and exposure. Serous effusion, thoracic deformity, malposition and capsular retractions can affect the result. Apart from breast reconstruction, expansion of the mammary region is useful in congenital malformations (glandular aplasia, Poland syndrome, severe asymmetry) and in acquired developmental abnormalities. Expansion has several indications in cosmetic surgery for certain cases of augmentation mammoplasty, correction of tuberous breasts and revision of certain mammoplasties.